{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE   M HILL","gend":1,"add":"2107 FOREST DR","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1969-04-10","age":"","mstatus":"","insh":"1998342*02","cliId":"","pno":"540\/949-0422","cno":"540\/949-0422","email":"","ename":"","eno":"","pphy":"CHEEK, KIMBERLY M MD","ppno":"540\/245-7950","pcpadd":"201 LEW DEWITT BLVD","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":151166,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"540\/949-0422","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R52.","R20.0","N34.2","G35.","M79.602","M25.512","Z01.419","H10.9","Z79.899"],"date":["2020-01-09","2020-01-09","2020-01-09","2021-06-18","2020-01-09","2020-01-09","2020-01-16","2021-06-08","2021-06-18"],"priorHcc":["","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","57237001999","DULOXETINE","60MG","90","Select","Select",""],["","13811071910","NITROFURANTN","100MG","30","Select","Select",""],["","60505252603","MODAFINIL","100MG","30","Select","Select",""],["","69097081312","GABAPENTIN","100MG","270","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","64406000801","TYSABRI","300\/15ML","15","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","60505252603","MODAFINIL ","100MG","30","Select","Select",""],["","57237001999","DULOXETINE ","60MG","90","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","30","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","270","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","8","Select","Select",""],["","64406000801","TYSABRI ","300\/15ML","15","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}